Older adults living in long-term care often take many medicines every day.
A large U.S. study suggests that carefully stopping some blood pressure medicines may not increase the risk of being hospitalized for a heart attack or stroke in certain residents.
The research focused on a practice known as deprescribing. This means a doctor reduces the dose of a medicine or stops it when the possible harms or burden of treatment may outweigh the benefits.
Deprescribing can be particularly important for frail older adults. As people age, their health, body weight, kidney function and response to medicines can change, meaning a drug that was useful years earlier may no longer provide the same balance of benefits and risks.
Blood pressure medicines are a good example. High blood pressure can damage arteries and increase the long-term risk of heart attacks and strokes, so controlling it is an important part of cardiovascular care.
However, lowering blood pressure too much can also create problems in some older people. It may contribute to dizziness, weakness or fainting and could increase the risk of falls, particularly in people who are frail or taking several medications.
Researchers led by Dr. Michelle C. Odden of Stanford University examined whether stopping blood pressure medicines was associated with more serious cardiovascular events among people living in long-term care facilities.
The study included 13,096 U.S. veterans who lived in long-term care between 2006 and 2019. Everyone included in the analysis was taking at least one medicine for high blood pressure.
The researchers observed medication changes over a 12-week period. About 17.8% of the residents had at least one antihypertensive medicine deprescribed, while the remaining residents continued their treatment.
The team then followed participants for up to two years. They looked specifically at hospital admissions for heart attacks and strokes, two major problems that blood pressure treatment is designed to help prevent.
Before researchers adjusted for differences between the groups, 11.2% of residents in the deprescribing group were hospitalized for a heart attack or stroke. The figure was 8.8% among residents who continued taking their blood pressure medicines.
Those raw percentages might appear to suggest greater risk among people who stopped medication. But residents chosen for deprescribing may differ from those who continue treatment in many ways, including age, frailty, illness and overall medical needs.
After the researchers used statistical methods to account for measured differences between the groups, they found no significant association between deprescribing blood pressure medicines and an increased risk of hospitalization for heart attack or stroke.
This result suggests that reducing medication may be reasonable for some long-term care residents. It does not mean that older people in general can safely stop taking their blood pressure medicines.
The decision to deprescribe is highly individual. Doctors may consider a person’s blood pressure, life expectancy, frailty, history of heart disease or stroke, risk of falls, other medicines and personal goals before changing treatment.
The study also has an important limitation: it was observational. Researchers studied what happened in real-world care rather than randomly assigning people to continue or stop their medicines.
Because of this, the study cannot prove that deprescribing is equally safe for everyone. Doctors may have been more willing to stop treatment in residents they believed could tolerate it, and factors that were not measured could have influenced the results.
The researchers said randomized clinical trials would provide stronger evidence. Such trials are difficult to conduct in long-term care populations because residents often have multiple illnesses, different levels of frailty and complex treatment needs.
Another consideration is that the participants were U.S. veterans, a population that may differ from other long-term care residents. Future studies involving more women and people from different healthcare settings could show whether the findings apply more broadly.
The research was published in JAMA Network Open. It adds to growing interest in reducing unnecessary medication use among older adults while making sure that important treatments are not removed without good reason.
The study’s main message is not that blood pressure medicines are unnecessary. Rather, it suggests that for carefully selected long-term care residents, reducing treatment may sometimes be possible without clearly increasing the risk of hospitalization for heart attack or stroke.
Patients and families should not stop prescribed blood pressure medicines on their own. Instead, the findings support regular medication reviews with healthcare professionals so that treatment can be adjusted as a person’s health, needs and priorities change.
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